Poulios Christos, Koletsa Triantafyllia, Goulas Antonis, Karayannopoulou Georgia, Vrettou Eleni, Kostopoulos Ioannis
Department of Pathology, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece.
Case Rep Pathol. 2013;2013:240758. doi: 10.1155/2013/240758. Epub 2013 Jun 19.
Reactive multinucleated osteoclast-like giant cells (OGCs) have been described in a variety of neoplasms but rarely in gastric carcinomas. Reported herein is a case of an 81-year-old Caucasian male presented with upper abdominal pain and dysphagia. Esophagogastroscopy revealed an ulcerative mass and a specimen of subtotal gastrectomy and lower esophagectomy was sent for histologic examination. At the gastroesophageal junction an exophytic tumor, measured 2.2 cm in greatest diameter, was observed. Sections from the tumor showed gastric adenocarcinoma, stage pT1bpN0. Diffusely among the neoplastic cells multinucleated giant cells, resembling osteoclasts, were observed, which were positive for CD68, lysozyme, and vimentin and negative for AE1/AE3, CK8/18, hHCG, and LMP1. Moreover, in a random section from the gastric fundus, a spindle cell lesion, sized 0.6 cm, was revealed, which was positive for CD117 and CD34 antigens and was diagnosed as gastrointestinal stromal tumor (GIST). The presence of OGCs is an uncommon finding in gastric carcinomas and by analogy to breast and pancreatic carcinomas it could characterize a rare distinct morphological variant of gastric adenocarcinoma. Due to the limited number of the reported cases, the prognostic value of OGCs is under discussion. Furthermore, pathologists should be aware that incidental GIST may accompany any tumor.
反应性多核破骨细胞样巨细胞（OGCs）已在多种肿瘤中被描述，但在胃癌中很少见。本文报告一例81岁白种男性，表现为上腹部疼痛和吞咽困难。食管胃镜检查发现一个溃疡性肿块，胃大部切除术和食管下段切除术的标本送组织学检查。在胃食管交界处观察到一个外生性肿瘤，最大直径为2.2厘米。肿瘤切片显示为胃腺癌，pT1bpN0期。在肿瘤细胞中广泛观察到多核巨细胞，类似于破骨细胞，其CD68、溶菌酶和波形蛋白呈阳性，而AE1/AE3、CK8/18、人绒毛膜促性腺激素和潜伏膜蛋白1呈阴性。此外，在胃底的随机切片中，发现一个大小为0.6厘米的梭形细胞病变，其CD117和CD34抗原呈阳性，被诊断为胃肠道间质瘤（GIST）。OGCs在胃癌中的存在是一种不常见的发现，类似于乳腺癌和胰腺癌，它可能是胃腺癌一种罕见的独特形态学变体。由于报告的病例数量有限，OGCs的预后价值正在讨论中。此外，病理学家应意识到偶然的GIST可能伴随任何肿瘤。
